January 9, 2017

Can disposable scopes fight infection?

Daily Briefing

    Several companies are now selling disposable scopes that they say are safer than reusable scopes, which can become contaminated by bacteria—including deadly superbugs, Chad Terhune reports for Kaiser Health News.

    Scopes help doctors inspect the digestive tract, respiratory system, and other areas of the body without resorting to surgery. They are a valuable tool for screening and diagnosing patients—but they also are a vector for infection. Each time a scope is inserted into a patient's body, it collects blood, mucus, and microbes.

    And because scopes contain sensitive equipment such as lights and cameras, they can't be "sterilized like a scalpel because intense heat would destroy crucial components," Terhune writes. Instead, the scopes are cleaned using disinfectants and with brushing and washing—which can cost as much as $75 each time.

    And despite hospitals' best efforts, some pathogens have made it through the cleaning process. For instance, according to FDA, as many as 350 patients at 41 medical facilities across the globe were infected by or exposed to contaminated gastrointestinal scopes between 2010 and 2015. Contaminated scopes have killed at least 35 U.S. patients since 2013.

    According to Terhune, "In one study, researchers found that more than 75 percent of colonoscopes and gastroscopes were still contaminated after cleaning and disinfection in accordance with manufacturer guidelines."

    The American Society for Gastrointestinal Endoscopy argues, however, that the low risk of infection is outweighed by the medical benefits that scopes provide. 

    New, disposable options

    Now, several companies are promoting single-use scopes as a safer alternative. In August, for instance, GI-View received FDA clearance for its single-use colonoscope, called Aer-O-Scope, which costs about $200. And Ambu A/S for several years has sold a $300 single-use bronchoscope in the United States.

    The single-use scopes are dramatically cheaper than multi-use, high-end scopes from companies such as Olympus—which can cost as much as $40,000.

    Some doctors say they are curious about single-use scopes but doubt they can provide the same high-quality images as traditional scopes or offer comparable high-end features. Simon Lo, a nationally known gastroenterologist at Cedars-Sinai Medical Center, said, "I'm not totally sold [that disposable scopes] will be comparable to the [conventional] scopes other companies have spent decades perfecting. … But this is a fantastic possibility and at least gives us an alternative to the current scopes."

    According to Terhune, single-use scopes might be most useful as tools for routine examinations and for immunosuppressed patients who are at high risk of infection. "For those patients, it would be great to use this and throw it away," Lo noted.

    Larger scope manufacturers seem to be taking a wait-and-see approach to the new disposable scopes. One, Fujifilm, told Kaiser Health News,  it "has no plans at this time to market single-use disposable scopes, and cannot speak to the benefits or risks associated with such products" (Terhune, Kaiser Health News, 12/15/16).

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